Prevention
The Effects of Maternal Cigarette
Smoking
By Terence T. Gorski
September 9, 2002
This
article is the lecture outline that I prepared for the conference The
World's Greatest baby Shower to be held in Hernando County
Florida. This presentation is designed to explain in simple and easy
to understand language why pregnant woman should quit smoking during
pregnancy, what it means to be addicted smoking, and how they can get help
if they can't quit smoking even though they know that they should.
1.
Cigarette smoking is inherently dangerous to all people including men,
women, and the unborn children of women who smoke.
2. All
pregnant women are at risk of harming their unborn babies to some degree
if they keep smoking cigarettes during pregnancy.
3. There
are two common set of problems that result from maternal smoking during pregnancy:
A.
The first set of problems is immediate. Pregnant women who smoke are
at greater risk of having their baby born with a low-birth-weight
that puts them at greater risk of miscarriage, premature births, birthing
complications, and early infancy (neonatal) illness.
Maternal cigarette smoking is the single largest modifiable risk factor
associated with reduced birth weight or increased risk of low-birth-weight
infants in developed countries. (Kramer 1998, 1987)
B.
The second set of problems is long-term. Pregnant women who smoke
are more likely to have children who developing learning disabilities,
attention deficit disorders, and mental retardation latter in life.
3. Many
pregnant woman do, in fact, cause harm to their unborn babies by
continuing to smoke during their pregnancy. This harm shows up most
clearly in the statistics related to low-birth-rate infants.
A.
In the United States, 65% of all infant deaths occur among
low-birth-weight infants who weigh less than 2500 g; (Guyer et al
1999)
B. Low-birth-weight
infants infants account for 7.6% of all live-born infants. (Guyer et
al 1999)
C.
Maternal smoking during pregnancy is one of a number of environmental and
genetic factors may play a role producing low-birth-weight infants.
(Wang et al 2002, 1995)
D.
Scientific studies have shown that maternal cigarette smoking during
pregnancy is associated with reduced birth weight or increased risk of
low-birth-weight infants. (Wang et al 2002)
4.
The amount of damage to the unborn baby by smoking during pregnancy will
depend upon three factors:
A.
The first factor is the stage of pregnancy during which the woman
smokes. Smoking in the earlier stages of pregnancy, especially
the first trimester, produces a greater risk than smoking during the
latter stages of pregnancy.
B.
The second factor is the number of cigarettes smoked per episode of and
the frequency of smoking episodes during each stage of the
pregnancy. The risk of damaging the unborn child goes up as
number of cigarettes smoked and the frequency of smoking goes
up.
C.
The third factor is the level of toxicity of both the the substances in
cigarette smoke that are directly inhaled chemicals and the intermediary
substances produced during the metabolism of the the inhaled toxic
substances. Let me explain what this means.
(1)
The body has a two step process for metabolizing (breaking down) the toxic
substances in cigarette smoke so they can be excreted from the
body.
During the first
step, which researchers call a metabolic activation process, the body
produces intermediate substances that can be broken down by and excreted
from the body. This is done by converting the inhaled toxins into
new chemical structures that are then connected with other
molecules. These intermediate substances may be more harmful than
the original toxic substances from which they are produced.
(National Research Council, 1983)
During the second
step, which researcher call the detoxification process, the
intermediate substances produced in the first step are transformed into
substances that can be excreted from the body. (Timbrell 1991)
(2)
As the level of toxicity of the substances produced at each of these steps
increases, the risk of physical harm the bodies of both the smoking
mother and the unborn baby also increases. (Bartsch et al 2000;
Brunnemann & Hoffmann 1991)
(3)
The level of toxicity of these intermediary substances is influenced by
the pregnant woman's genetic predisposition. (Wang et 2002)
In other words, even though all pregnant women who smoke and their unborn
children are at risk, some women women have a genetically genetically
higher risk of damage than others.
The problems is that there is currently no way of identifying these
genetic risk factors. The methods used in this research are so
expensive and time consuming that they cannot be used in routine medical
practice.
5.
In spite of these risks, many women continue to smoke during their
pregnancy.
A.
In 1997, 13.2% of US women reported smoking cigarettes during pregnancy. (Guyer
et al 1999)
B.
The actual number of women who keep smoking during pregnancy is probably
higher than this. This figure is based upon unconfirmed
self-reports. Since many women know that it can be harmful to their
unborn babies to smoke during pregnancy, it is unlikely that all women
responding to the survey who continued to smoke would honestly report it.
6. There
are three primary reasons why pregnant women continue to smoke.
A.
They don't know or don't really believe that smoking can damage
"their" unborn baby. Not knowing that smoking can
damage an unborn baby is extremely rare. Most women know that
smoking can be harmful to their unborn baby. They learn this from
their health care providers, from the media, and from the warning labels
on every pack of cigarettes. Not believing it can happen to
"my baby" is a lot more common. Many women just
believe they're immune and their smoking can't harm "their"
baby. They believe that kind of thing only happens to other people.
B.
They don't care. They know that smoking can be harmful to
their unborn child but they don't care enough about what happens to the
child to quit. This is also rare, but it does occur in immature and
self-centered women who "accidentally" get pregnant and resent
the baby for interfering with their life plans.
C.
They're addicted and can't quite even though they want to.
This is the most common reason. Many women know that smoking can be
harmfully to their unborn babies. They also care about and would do
anything to want to protect their unborn child from harm. So they
make up their mind to quite, they try to stop, but feel overwhelming
cravings or urges to start smoking again. They start to feel so bad
when they're not smoking that they can't stand it. So, in a moment
of desperation, they start smoking again. Then they feel regret --
they're guilty, ashamed, and afraid of what might happen to their
baby. So they try to quite again. Many women go through this
cycle of quitting, relapsing, and regretting over and over again during
their pregnancy. They never stop to think that they might be
addicted to cigarettes.
7. Cigarettes
Are Addictive: Many pregnant women continue to smoke during
pregnancy because they are addicted to smoking cigarettes.
A.
Tobacco smoke contains contains addictive substances that are inhaled with
each puff. These substances are addictive because they can
create ...
(1)
A need to smoke cigarettes in order to feel and function normally,
(2)
An inability to stop or stay stopped in spite of a strong desire to quite
based upon accurate knowledge of the adverse effects smoking can have on
both the mother and the unborn baby.
B.
Unfortunately, cigarette manufacturers have a good job in two areas:
(1) Creating ways
of manufacturing cigarettes that make them highly addictive, and
(2) Convincing
people, especially smokers, of the "big lie" ---
"normal people" can't get addicted to cigarettes.
What makes cigarettes addictive? There are a number of things
C. Cigarette
smoking can and often does become an addiction that is more powerful than
addiction to alcohol, narcotics, and even cocaine.
D. The
primary addictive substance in cigarette smoke is nicotine.
E.
Nicotine is a mind-altering drug that produces a fast-acting low-grade
stimulant high that quickly wears off. Let's break this
complicated sentence into some easy to understand parts.
(1)
Nicotine mood altering -- it causes people to "get high".
When people "get high" they experience a change in mood
or emotion as a result of using a drug.
(2)
Nicotine is a mind altering drug. It changes people's mood
and emotions by changing the chemical processes that occur in the brain.
(3)
Nicotine is a stimulant drug that is similar to caffeine,
amphetamine, and cocaine. As a stimulant drug, nicotine changes
brain chemistry in way that gives people a feeling of increased
energy. At very high does it can people jittery.
(4)
When people get a "stimulant high", the drug
effect gives them a sense of increased energy.
(5)
When people use get a fast-acting high, the drug works quickly by
producing its mood altering effect in a short period of time.
(6)
When a drug high "quickly wears off", the
drug effect tends to last for only a brief moment. So if you want to
keep feeling the way the drug makes you feel, you have to keep taking more
of the drug each time its effect starts to wear
off.
F. Nicotine
Tolerance: People who develop a tolerance to nicotene need to
keep smoking more in order to get the same mood-altering and mind-altering
effect
(1)
Most cigarette smokers will remember the days when each puff of a
cigarette quickly gave them smoker a small shot of energy that lasted for
a short period of time.
(2) Addicted
smokers will tell you that they had to take more puffs, over a shorter
period of time, while inhaling more deeply in order to keep getting the
same feeling.
(3) This is because
people who smoke regularly and heavily
can develop tolerance to the effects of
nicotine.
(6)
When people develop tolerance means that they have to take more puffs,
more quickly, and inhale more deeply to get the same energizing effect
that they once were able to get with fewer puffs, taken more slowly, while
inhaling less deeply.
G.
Nicotine Withdrawal: People can experience nicotine
withdrawal when they try to stop smoking cigarettes. These
withdrawal symptoms get progressively worse over a period of five to seven
days and quickly go away when people start smoking again. The
symptoms of nicotine withdrawal are:
(1)
Strong cravings for cigarettes and often for sugar and sweets. (A
craving is a strong irrational urge to start smoking again even though you
don't want to),
(2)
Depressed mood,
(3)
Insomnia (inability to sleep restfully),
(4)
Feeling irritable, frustrated, and anger for no apparent reason,
(5)
Feeling anxious or scared for no apparent reason,
(6)
Having difficulty concentrating.
H.
Depression & Smoking: Addicted smokers who stop
smoking for period of several weeks often find themselves developing
serious problems with depression. This is may be caused by the
tendency of heavy smoking to inhibit the production of serotonin and other
naturally occurring brain chemicals that have antidepressant effects.
References
Brunnemann
K, Hoffmann D. Analytical studies on tobacco-specific N-nitrosamines
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MEDLINE
Bartsch
H, Nair U, Risch A, et al. Genetic polymorphism of CYP genes, alone
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Guyer
B, Hoyert DL, Martin JA, et al., Annual summary of vital statistics
1998.,
Pediatrics. 1999;104:1229-1246. MEDLINE
Kramer
MS. Socioeconomic determinants of intrauterine growth
retardation. Eur J Clin Nutr. 1998; 52(suppl
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Kramer
MS. Intrauterine growth and gestational duration determinants. Pediatrics.
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Timbrell
J. Principles of Biochemical Toxicology. 2nd ed.
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X, Zuckerman B, Coffman GA, Corwin MJ.; Familial aggregation of low
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Wang,
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